重症頭部外傷に対する低体温法の使用経験

概要

論文の詳細を見る
Twenty patients with severe head injury were treated under hypothermia with barbiturate and hyperventilation. Indications for hypothermia were 1: younger aged acute head injuries, 2: Glasgow Coma Scale 3 to 5 without severe cardio-pulmonary complications, 3: presence of spontaneous respiration. Hematomas with surgical indications were evacuated before the procedure. Surface cooling was applied with accurate cardio-pulmonary monitoring. Steroid, large dosis of thiopental and hypertonic diuretics were used routinely. Dopamine was administered when the blood pressure was low to maintain the cerebral perfusion pressure of normo-thermia. The average duration of hypothermia at 30℃ was 6.6 days. In 7 cases with primary brain stem injury, 3 died and 4 recovered with mild to moderate disability. In 13 cases with secondary brain stem injury, 2 died and 3 showed excellent recovery without any defects. Eight cases recovered with mild to moderate disability. The overall mortality rate was 25% and none remained in a persistent vegetative state. When compared with other series of severe head injury treated with barbiturate and hyperventilation, the mortality and morbidity rates were improved by application of hypothermia.
日本脳神経外科学会の論文
1985-04-15